Life stress and the symptoms of major depression

Depression and associated factors in medical students in Acapulco during the COVID-19 pandemic: A cross-sectional study

BACKGROUND

Depression is common in medical students and the Mexican state of Guerrero has the highest rates of depression in the country. Acapulco, the seat of the state medical school, is a tourist destination that experienced early high rates of COVID-19. The COVID-19 pandemic closed all schools in Mexico, obliging a shift from face-to-face to virtual education. In this new context, medical students faced challenges of online teaching including inadequate connectivity and access technologies. Prolonged isolation during the pandemic may have had additional mental health implications.

AIM

Assess depression prevalence and its associated factors affecting medical students in Acapulco, Mexico during the COVID-19 pandemic.

METHODS

A cross-sectional survey of students of the Faculty of Medicine of the Universidad Autónoma de Guerrero, in November 2020. After informed consent, students completed a self-administered questionnaire collating socio-demographic, academic and clinical variables, major life events and changes in mood. The Beck inventory provided an assessment of depression. Bivariate and multivariate analyses relied on the Mantel-Haenszel procedure to identify factors associated with depression. We estimated the odds ratio (OR) and 95% confidence intervals.

RESULTS

33.8% (435/1288) of student questionnaires showed evidence of depression in the two weeks prior to the study, with 39.9% (326/817) of young women affected. Factors associated with depression included female sex (OR 1.95; 95%CI 1.48-2.60), age 18-20 years (OR 1.36; 95%CI 1.05-1.77), perceived academic performance (OR 2.97; 95%CI 2.16-4.08), perceived economic hardship (OR 2.18; 95%CI 1.57-3.02), and a family history of depression (OR 1.85; 95%CI 10.35-2.54). Covid-19 specific factors included a life event during the pandemic (OR 1.99; 95%CI 1.54-2.59), connectivity problems during virtual classes and difficulties accessing teaching materials (OR 1.75; 95%CI 1.33-2.30).

CONCLUSIONS

The high risk of depression in medical students during the COVID-19 pandemic was associated with perceived academic performance and technical barriers to distance learning, in addition to known individual and family factors. This evidence may be useful for the improvement of programs on prevention and control of depression in university students.

Tobacco Usage and Its Association With Mental Health Status of School-Going Adolescents Near Patna, Bihar: A Community-Based Cross-Sectional Study in Eastern India

Background Of all the adolescents in India, 7.3% are suffering from some form of mental disorder. They frequently use tobacco to cope with these problems, but get stuck in a vicious cycle of deteriorating mental health. Our study aimed to determine the effect of tobacco on the mental health status of adolescents studying in the 9th to 12th standards in 10 high schools in urban and rural areas near Patna, Bihar. Methodology An analytical cross-sectional study was conducted among 360 school-going adolescents recruited using stratified random sampling. Selected adolescents were given the Indian Adolescent Health Questionnaire. The mental health status was calculated from the Strengths and Difficulties Questionnaire (SDQ) score. Information on sociodemographic characteristics and tobacco use was also obtained. Independent t-test, analysis of variance, and multiple linear regression analysis were used for predicting the significant factors. Significance was set at p-values <0.05. Results In this study, 40 (11.1%) adolescents had abnormal whereas 55 (15.3%) had borderline overall SDQ scores. The majority of those affected had peer problems (40%) and conduct problems (24.7%). All SDQ components of conduct (F = 2.94, p = 0.013), hyperactivity (F = 2.90, p = 0.014), emotional problems (F = 1.14, p = 0.001), and peer pressure (F = 3.06, p = 0.010), as well as the overall SDQ score (F = 5.74, p < 0.001), were significantly associated with increasing age. The adolescents attending rural schools (13.28 ± 5.22, p = 0.047) had significantly higher SDQ scores than those attending urban schools (12.08 ± 5.60). Hyperactivity scores were significantly higher in those studying in class 10 compared to other classes and in those attending rural rather than urban schools. Emotional problems score was significantly higher in 16-17-year-old students than in 14-15-year-old students, in females than in males, and in class 10 than in class 9 students. Only 24 (6.7%) adolescents had a history of tobacco consumption at least once which was significantly associated with the SDQ score (17.71 ± 5.69; t = 4.95, df = 358, p < 0.001). Around 79.4% of adolescents were exposed to passive smoking from close friends which deteriorated their overall mental health status (14.50 ± 5.99; F = 6.29, df = 2,357, p = 0.002). Those who had smoked for more than 10 days had significantly greater conduct problems and lesser pro-social behavior. Overall, 96.1% agreed that tobacco is harmful to health, and 76.1% had seen anti-smoking messages in the media. Female gender, increasing class and age, and history of smoking or chewing tobacco at least once also led to a significant increase in emotional problems. Age, area of the school, history of tobacco consumption, and exposure to cigarette smoke by either a close friend or male guardian had a significant impact on the conduct, hyperactivity, peer problems, and overall mental health status of school-going adolescents. Conclusions Predicting risk factors such as age, area of the school, and the history of tobacco consumption by self or by close friends is important for decision-making by school administration regarding counseling for mental health and preventing tobacco use.

Leisure behavior and sense of coherence in the context of depression

AIMS

Improved sense of coherence (SOC) can protect health among individuals with depression. Literature suggests that leisure behavior can improve SOC, yet empirical studies are lacking. The current study aimed to examine whether leisure behavior was associated with SOC and depression.

METHODS

A cross-sectional online survey method was used with a sample of community-living adults (62% female, age 18-75 years) with a self-reported current or historical diagnosis of depression recruited from four different depression-related populations.

RESULTS

The results of structural equation modeling found that leisure behavior predicted greater SOC as well as lower depressive symptoms. Greater SOC was associated with lower perceived stress and lower depressive symptoms. The total effect size, including both direct and indirect association between leisure behavior and depressive symptoms was 0.452.

CONCLUSION

The findings suggested the potential benefits of leisure behavior on SOC and depressive symptoms.

Serum Vitamin D Concentrations Are Associated With Depressive Symptoms in Men: The Sixth Korea National Health and Nutrition Examination Survey 2014

OBJECTIVE

There is increasing evidence of an inverse association between serum vitamin D concentrations and depression, but whether there are sex-specific differences remains controversial. Thus, the aim of this study was to investigate the association between serum vitamin D concentrations and specific domains of depressive symptoms by each sex in the Korean general population.

METHODS

The study sample comprised 820 men and 916 women, aged from 19 to 76, who participated in the Korea National Health and Nutrition Examination Survey 2014. Participants completed health interviews and health examinations providing data of serum 25-hydroxyvitamin [25(OH)D] concentrations, the Patient Health Questionnaire-9 (PHQ-9), and certain covariates. Associations were analyzed using negative binomial regression.

RESULTS

After adjusting for various covariates, the association between log-transformed serum 25(OH)D concentrations and total PHQ-9 scores was statistically significant {incidence rate ratio [IRR] = 0.74 [95% confidence interval (CI) = 0.59-0.93]} only in men. Additionally, the association between log-transformed serum 25(OH)D concentrations and the PHQ-9 cognitive/affective subscore was statistically significant [IRR = 0.56 (95% CI = 0.40-0.80)] only in men. There was no association for the somatic subscore.

CONCLUSIONS

Serum vitamin D levels were inversely associated with cognitive/affective depressive symptoms only in men.

Social Support Moderates the Association Between Traumatic Life Events and Depression Among Migrant and Nonmigrant Men in Almaty, Kazakhstan

Across cultures, experiencing traumatic life events, particularly violence, is a salient predictor of depression. Some previous findings have shown that social support can serve as a buffer in the association between traumatic life events and depression (i.e., the buffering hypothesis) in that individuals with a high level of social support have a decreased or nonexistent association between traumatic life events and depression. The purpose of this study was to test the buffering hypothesis among a sample of 1,342 male migrant and nonmigrant market vendors in Almaty, Kazakhstan. Using multiple-group structural equation modeling (SEM), we identified the following results: (a) higher levels of traumatic life events were associated with higher depression scores, (b) higher social support scores were associated with decreased depression scores, and (c) social support buffered the association between traumatic life events and depression among migrants and nonmigrants. The final model accounted for 45.0% and 38.4% of the variance in depression for migrants and nonmigrants, respectively. Findings suggest that social support may be an important protective factor for men in Kazakhstan who have experienced trauma and call for an incorporation of social support interventions for migrant and nonmigrant men experiencing depression.

Tinnitus, depression, and suicidal ideation in adults: A nationally representative general population sample

Tinnitus is strongly associated with psychiatric symptoms, including depression and suicidality. We aimed to further investigate the association of tinnitus with depressive mood and/or suicidal ideation, and explore the shared risk factors for these within a representative sample of the adult general population. We also investigated potential mediation pathways among tinnitus, suicidal ideation, depression, shared risk factors, and perceived stress levels. We analysed data from 28,930 adults (aged ≥19 years) from the fourth and fifth Korea National Health and Nutrition Examination Surveys (KNHANES) conducted from 2008 to 2012 in South Korea. We investigated the presence and severity of tinnitus, depressive mood, suicidal ideation, perceived usual stress level, and socioeconomic and health-related variables. We conducted logistic regression and mediation analyses. Tinnitus and its severity were significantly associated with depressive mood and suicidal ideation. Tinnitus, depressive mood, and suicidal ideation shared common socioeconomic and health-related risk factors. Tinnitus significantly mediated the association of shared risk factors for depressive mood and suicidal ideation. Perceived usual stress level mediates the association of tinnitus with depressive mood and suicidal ideation. The correlation of perceived usual stress levels with depression and suicidal ideation was also mediated by tinnitus. Our findings implicate that tinnitus may contribute substantially to the development of depressive symptom and suicidal ideation in adults via apparent interactions with shared risk factors and stress levels.

[Risk Factors for Suicidal Ideation in Patients with Depressive Disorders in Colombia]

INTRODUCTION

Suicidal ideation is a poor prognostic factor in patients with depression, due to the risk of suicide attempt or completed suicide. However, it is a relatively unexplored aspect in the Colombian population. It is important to identify the associated factors in order to develop appropriate treatment strategies.

OBJECTIVE

To identify risk factors for suicidal ideation in patients with major depressive disorder between 18 and 65 years in 5 Colombian cities.

METHODS

Data from 295 patients diagnosed with major depressive disorder were used from the Study of the Economic Burden of Depression in Colombia. The association between the clinical and psychosocial variables with the presence of suicidal ideation was assessed using two-level hierarchical models.

RESULTS

Female sex was a factor associated with a lower risk of suicidal ideation. Factors associated with the presence of suicidal ideation include unemployment, smoking and alcohol use in the past 30 days, mental health perceived as fair or poor, diagnosis of double depression, inpatient treatment, low income, unemployment, and a major financial crisis in the last 2 years.

CONCLUSIONS

Suicidal ideation is highly prevalent in patients with major depressive disorder. Risk factors associated with both the clinical and psychosocial domain must be carefully evaluated during risk assessment of patients with this diagnosis.

Fluctuations of suicidality in the aftermath of a marital separation: 6-month follow-up observations

BACKGROUND

There is a lack of understanding of how the changing nature of the separation process impacts on suicidality.

AIMS

This paper aims to identify factors contributing to fluctuations in suicidality during the process of marital/de facto separation along a 6-month follow-up.

METHOD

Separated persons who had contacted relationship-counselling services, help-line services, and variety of support and self-help groups were asked to participate in the first assessment. A 'Follow-Up Questionnaire' was sent 6 months later. Participants were required to be 18 years or older and separated from their married/de facto partner within the previous 18 months but not yet divorced.

RESULTS

Overall, in the first assessment, separated females presented lower levels of suicidality than males. During the follow-up suicidality decreased. There were some gender differences in terms of predictors of changes in suicidality. Separated males who showed an increase or stability in suicidality were more affected by stressful experiences such as legal negotiations on obtaining a divorce, feelings of loss and loneliness, loss of social networks and financial difficulties than males who were not suicidal in either assessment. Separated males and females who remained suicidal were more likely to report different mental and physical illnesses.

LIMITATIONS

Relatively low response rates of the follow-up (60%) limited our statistical analyses as some of the groups were too small and did not enable modelling.

CONCLUSIONS

Suicidality decreased, which seems to indicate that individuals adjusted to their new life circumstances. However, persons whose suicidality remained or increased reported more frequently stressful life events, physical and mental illnesses.

Major depression across West Bank: a cross-sectional general population study

BACKGROUND

In recent decades entire populations have been living under chronic strain, apprehension and violence. This is the case for Palestinians. Despite the increased volume of mass media attention on this situation, little is known about the psychological effects of this condition on this population.

AIMS

The study was designed to investigate the lifetime and one-month prevalence of major depression episode (MDE) in a multi-stage sample of 916 adult Palestinians drawn from the Al-Aqsa Intifada.

METHODS

The survey was based on personal interviews and was carried out from February to September 2007. The clinical examination used DSM-IV criteria for the detection of MDE, extracted from SCID-I. Data, suicidal behaviour, previous help seeking, medication use and exposure to trauma were also collected.

RESULTS

Lifetime and one-month prevalence of MDE was found to be 24.3% and 10.6%, respectively. Male Palestinians suffered from slightly higher rates of MDE than their female counterparts, but this difference was not statistically significant. Being widowed and living in towns in West Bank also increased the likelihood to develop MDE. A comparison of prevalence rates in refugee and non-refugee populations showed no significant differences. This could be explained by the fact that though refugees were forcibly displaced, they were living among compatriots (non-refugees), thus both groups were experiencing the same sociopolitical adversities. Being also exposed to traumatic events increased the risk of suffering from MDE.

CONCLUSIONS

This study provides evidence that a population under continuous strain and apprehension, living in unremitting socioeconomic deprivation, is more likely to suffer from major depression.

Secondhand smoke exposure and mental health among children and adolescents

OBJECTIVE

To examine a potential association between biologically confirmed secondhand smoke exposure and symptoms of Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition) (DSM-IV) major depressive disorder, generalized anxiety disorder, panic disorder, attention-deficit/hyperactivity disorder, and conduct disorder using a nationally representative sample of US children and adolescents.

DESIGN

Nationally representative cross-sectional survey of the United States.

SETTING

Continental United States.

PARTICIPANTS

Children and adolescents aged 8 to 15 years who participated in the National Health and Nutrition Examination Survey from 2001 to 2004.

INTERVENTION

Measurement of serum cotinine level to assess secondhand smoke exposure among nonsmokers.

MAIN OUTCOME MEASURES

The DSM-IV symptoms were derived from selected modules of the National Institute of Mental Health's Diagnostic Interview Schedule for Children Version IV, a structured diagnostic interview administered by trained lay interviewers.

RESULTS

Among nonsmokers, serum cotinine level was positively associated with symptoms of DSM-IV major depressive disorder, generalized anxiety disorder, attention-deficit/hyperactivity disorder, and conduct disorder after adjusting for survey design, age, sex, race/ethnicity, poverty, migraine, asthma, hay fever, maternal smoking during pregnancy, and allostatic load. Associations with serum cotinine level were more apparent for boys and for participants of non-Hispanic white race/ethnicity.

CONCLUSIONS

Our results are consistent with a growing body of research documenting an association between secondhand smoke exposure and mental health outcomes. Future research is warranted to establish the biological or psychological mechanisms of association.

Fibromyalgia syndrome and depressive symptoms: comorbidity and clinical correlates

OBJECTIVE

Fibromyalgia is characterized by chronic widespread musculoskeletal pain and higher pain perception in specific anatomic sites called tender points. Fibromyalgia is frequently associated with psychiatric symptoms, like depression and anxiety; indeed some authors have argued about the possibility to classify this syndrome into affective spectrum disorder. Few studies have analyzed the impact of depressive symptoms on pain threshold. This research is aimed at evaluating the prevalence and the clinical correlates of depressive symptoms in fibromyalgic patients, and investigating their impact on pain perception and quality of life.

METHODS

Outpatients between 18 and 75 years with diagnosis of fibromyalgia according to the criteria of the American College of Rheumatology have been included. All subjects have been evaluated with the following rating scales: HAM-D; VAS (to quantify pain); a visual analogical scale to evaluate quality of life; and Paykel's List of Recent Life Events.

RESULTS

Thirty subjects have been recruited. Most patients (83.3%) had clinically significant depressive symptoms as indicated by a HAM-D score >7. Depressive symptoms are associated with higher pain perception, worse quality of life and more severe life events.

CONCLUSION

The presence of depressive symptoms is associated with a great impairment in patients with fibromyalgia syndrome: indeed the psychiatric comorbidity lowers pain threshold and worsens the quality of life of our patients. Future studies should be conducted in order to identify the individual factors, e.g. stress or inflammatory processes, which drive the association between depression and higher severity of fibromyalgia syndrome.

The impact of decreased environmental reward in predicting depression severity: support for behavioral theories of depression

Insufficient response-contingent positive reinforcement and decreased environmental reward have been hypothesized to directly contribute to the onset and persistence of depression. The present study examined whether decreased environmental reward was significantly associated with self-reported depression and diagnosed major depression relative to other well-established risk factors that included gender, stressful life events, traumatic life events, childhood maltreatment, and cognitive vulnerability. Based on hierarchical regression analyses, all variables except gender were significantly associated with self-reported depression, and stressful life events, cognitive vulnerability, and decreased environmental reward were associated with diagnosed depression. Of all variables, decreased environmental reward was most strongly related to both self-reported depression and diagnosed clinical depression. The incremental validity of environmental reward in predicting self-reported depression and clinical depression was established, accounting for significant unique variance (12%) in each regression equation. Implications for conceptualizing and treating depression are discussed.

Do stress hormones connect environmental effects with behavior in the forced swim test?

Forced swim test (FST) is a widely used test for antidepressant development. Depression is a stress related disease, as hormones of the stress-axis can modify mood. However it is not clear, how the appearance of depressive-like behavior (floating) in FST is connected with changes in the stress-hormone levels. We hypothesized, that different manipulations would alter the behavior through changes in stress-hormone levels. First the effect of environmental alterations was studied. Increasing water-temperature enhanced floating time together with a decrease in adrenocorticotropin levels. During the dark phase of the day rats spent more time with floating independently from the actual lighting. Neither the phase nor the actual lighting had significant effect on adrenocorticotropin concentrations with higher corticosterone levels during the dark phase. At greater water depth rats float less but the size of animals had no effect. Water depth did not influence adrenocorticotropin and corticosterone responses, but the size of the rats significantly affected both factors. Secondly, administration of imipramine reduced floating and adrenocorticotropin level without affecting corticosterone. Despite the known connection between depression and stress we did not find a correlation between floating behavior and hormone levels. As an alternative mechanism imipramine-induced heart rate and core body temperature decrease was found by telemetric approach. This study is the first summary in rats examining the effect of wide range of environmental alterations during FST. It seems likely that both brain monoamines and stress-axis take part in the development of depression, but these pathways are regulated independently.

Stressful life events, cognitive symptoms of depression and response to antidepressants in GENDEP

BACKGROUND

The occurrence of stressful life events (SLEs) has been shown to predict response to antidepressants; however, results are inconsistent. There is some evidence to suggest that SLEs prior to treatment are associated with greater cognitive symptoms at baseline and may therefore predict changes in these symptoms specifically.

METHODS

GENDEP, a prospective part-randomised pharmacogenomics trial, collected longitudinal data on the symptoms of patients with major depression treated with either a selective serotonin reuptake inhibitor (SSRI, escitalopram) or a tricyclic antidepressant (TCA, nortriptyline). Data on life events experienced in the 6 months preceding treatment measured using the List of Threatening Experiences Questionnaire (LTE-Q) were available for 728 participants.

RESULTS

Both the occurrence and number of SLEs were associated with greater cognitive but not mood or neurovegetative symptoms prior to treatment. Those who reported SLEs also experienced a greater decline in cognitive symptoms during treatment with escitalopram, but not with nortriptyline.

LIMITATIONS

Life events were measured retrospectively using a self-report checklist and are therefore subject to a number of biases especially in the context of depressive illness.

CONCLUSIONS

These findings are in line with cognitive theories of depression and suggest that symptomatic heterogeneity may have contributed to inconsistencies in studies reported to date. Our results also tentatively suggest a clinically relevant drug specific effect of SLEs. Specifically, those reporting stress may benefit more from treatment with SSRIs than TCAs.

Comorbidity: a network perspective

The pivotal problem of comorbidity research lies in the psychometric foundation it rests on, that is, latent variable theory, in which a mental disorder is viewed as a latent variable that causes a constellation of symptoms. From this perspective, comorbidity is a (bi)directional relationship between multiple latent variables. We argue that such a latent variable perspective encounters serious problems in the study of comorbidity, and offer a radically different conceptualization in terms of a network approach, where comorbidity is hypothesized to arise from direct relations between symptoms of multiple disorders. We propose a method to visualize comorbidity networks and, based on an empirical network for major depression and generalized anxiety, we argue that this approach generates realistic hypotheses about pathways to comorbidity, overlapping symptoms, and diagnostic boundaries, that are not naturally accommodated by latent variable models: Some pathways to comorbidity through the symptom space are more likely than others; those pathways generally have the same direction (i.e., from symptoms of one disorder to symptoms of the other); overlapping symptoms play an important role in comorbidity; and boundaries between diagnostic categories are necessarily fuzzy.

Cumulative adversity and depressive symptoms among older adults in Israel: the differential roles of self-oriented versus other-oriented events of potential trauma

BACKGROUND

The study examined the association between cumulative adversity and current depressive symptoms in a national sample of Israelis aged 50+. Referring to cumulative adversity as exposure to potentially traumatic events along life, the study distinguished between events primarily inflicted upon the self (self-oriented adversity) versus upon another person (other-oriented adversity).

METHOD

Data were drawn from the Israeli component of the Survey of Health, Aging and Retirement in Europe (SHARE). During 2005-2006, 1710 Jews and Arabs completed an inventory of potentially traumatic events and two measures of depressive symptoms: the European Depression scale (Euro-D) and the Adapted Center for Epidemiological Studies-Depression scale (ACES-D). The Euro-D is more detailed in querying cognitions and motivations while the ACES-D is more detailed in querying feelings and social alienation.

RESULTS

In line with the hypothesis, self-oriented adversity had a positive association with depressive symptoms whereas other-oriented adversity had either no association or an inverse association with depressive symptoms. Sociodemographic characteristics and perceived health were controlled in the multivariate regressions.

CONCLUSIONS

The differential association of self- versus other-oriented adversity with depressive symptoms may be explained in terms of social commitments that are inherent in other-oriented adversity and incompatible with depressive symptoms. The study points to the variations in the symptom compositions represented by the Euro-D and ACES-D, with the latter better capturing the difference between self- and other-oriented adversities.

Risk markers for depression in adolescents: sleep and HPA measures

Previous work has demonstrated reliable electroencephalographic (EEG) sleep and hypothalamic-pituitary-adrenal (HPA) changes associated with adult major depressive disorder. These changes might be evident before clinical manifestation of the illness in at-risk persons. The aim of the study was to identify depression-related EEG sleep and HPA changes in healthy adolescents at high risk for depression, and to examine the relationship between EEG sleep (or HPA) changes and the onset of depression. Forty-eight adolescent volunteers with no personal history of a psychiatric illness, including depression, but who were at high risk for developing depression by virtue of parental depression (high-risk group), and 48 adolescent volunteers with no personal or family history of a psychiatric disorder (normal controls) were recruited. EEG sleep and HPA measures were collected on three consecutive evenings and nights at baseline. Clinical follow-up evaluations were conducted at regular intervals over a 5-year period. Compared with normal controls, adolescents at high risk for depression had shorter latency to rapid eye movement (REM) sleep, increased phasic REM sleep, more REM sleep and elevated nocturnal urinary-free cortisol (NUFC) excretion at baseline. Shorter REM latency, higher REM density and elevated NUFC (measured at baseline) were associated with the development of depression during follow-up. The findings that REM sleep abnormalities and elevated HPA activity occur before the onset of depression in at-risk adolescents suggest that these variables serve as vulnerability markers for the illness.

Stressful life events, chronic difficulties, and the symptoms of clinical depression

Major life events and chronic difficulties have been found to be associated with the onset of depression. Little is known, however, about how exposure to such stressors is related to the clinical presentation of this disorder. We addressed this issue by administering an interview-based measure of life stress, the Beck Depression Inventory, and the Global Assessment of Functioning scale to 100 adults diagnosed with major depressive disorder. Participants who experienced a preonset severe life event exhibited greater overall levels of depression severity, endorsed more cognitive and somatic symptoms of depression, and functioned at lower levels than did their counterparts without preonset severe life events. In contrast, exposure to a preonset severe difficulty was unrelated to participants' severity of depression, cognitive and somatic symptoms, or level of global functioning. These findings highlight the potentially greater importance of acute stress compared with chronic stress for influencing these key clinical features of depression.

Traumatic stress and suicidal ideation in Norwegian male peacekeepers

To investigate the association between war zone stress exposure during international military operations and later suicidal ideation, a follow-up study of 1172 Norwegian male peacekeepers was conducted 7 years, on average, after redeployment. Suicidal ideation was reported in 6% of the veterans, while it was reported in 17% of the subsample of those who were prematurely repatriated. Suicidal ideation was significantly associated with service stress exposure level, even when background factors, repatriation status, negative life events, social support, alcohol consumption, and marital and occupational status were controlled for. Results indicate that the association between service stress exposure and suicidal ideation was mediated by posttraumatic stress symptoms and general mental health problems combined.

Depressive symptoms after trauma: is self-esteem a mediating factor?

Traumatic events have predicted depressive symptoms. Despite this consensus, it remains unclear as to whether the relationship between trauma and depression is consistently mediated by a negative cognitive schema, such as low self-esteem, or whether trauma influences mood independently of low self-esteem. This study tested these relationships while considering depressive symptom types. One hundred thirty-two students reported the number of traumatic events experienced and self-esteem and depression levels. Results indicated 2 depressive symptom types: "cognitive-affective" and "somatic." Structural Equation Modeling tested an unmediated path from trauma to depressive symptoms and a path mediated by self-esteem. Results supported the unmediated relationship between trauma and "cognitive-affective" depressive symptoms, and did not support mediation by self-esteem. Findings are discussed in view of a dimensional rather than categorical approach to depression, and in consideration of alternative symptom clusters resulting from trauma in addition to those captured by posttraumatic stress disorder.

Decline in suicidal ideation among patients with MDD is preceded by decline in depression and hopelessness

BACKGROUND

Suicidal ideation is likely to represent a phase preceding suicidal acts among most suicidal patients with major depressive disorder (MDD). Factors predicting reversal of the suicidal process are unknown. Our aim was to test the hypothesis that a decline in suicidal ideation is preceded by a decline in hopelessness among patients with MDD.

METHOD

Of the 269 Vantaa Depression Study patients with DSM-IV MDD, 103 patients scored > or = 6 points at baseline on the Scale for Suicidal Ideation (SSI). Seventy of these patients were followed-up weekly either until they scored zero points on the SSI, or up to 26 weeks.

RESULTS

The median duration for a decline of suicidal ideation to zero was 2.2 months after baseline. The level of baseline suicidal ideation, depressive symptoms, and the presence of any personality disorder predicted duration of suicidal ideation. A decline in both depression (BDI) and hopelessness (HS) independently predicted a decline in suicidal ideation.

LIMITATIONS

Due to study design, we do not know if suicidal ideation relapsed after the first time the patient reached zero score in the SSI.

CONCLUSIONS

Among patients with major depressive disorder having suicidal ideation, the decline in suicidal ideation is independently predicted by preceding declines in the levels of both depressive symptoms as well as hopelessness. The findings are consistent with possible causal roles of declines in depression and hopelessness in reversing the suicidal process.

Life events and clinical subtypes of major depression: a cross-sectional study

The present study aimed to investigate the relationship between stressful life events and depression. Ninety major depressive patients, aged 36.57 +/- 12.02 years, and 121 matched controls, aged 27.11 +/- 10.59 years, took part in the study. The life change units (LCU) according to Rahe et al. were used for the quantification of life events. The results suggested that males reported significantly more life events than females. Atypical males differed from all other gender-by-type groups, while no other differences emerged. LCU correlated with melancholic indices but did not correlate with anxiety or functioning. The results suggest that subgroups of depressive patients are characterized by the presence of stressful life events. Male atypical patients reported the highest load of life events. The question that arises is whether this finding is valid or whether these patients (who have higher personality psychopathology and interpersonal rejection sensitivity) tend to over-report life events.

Using the short mood and feelings questionnaire to detect depression in detained adolescents

The Mood and Feelings Questionnaire (MFQ) is examined for its utility in screening youth in juvenile justice settings for depression. In a cross-sectional study conducted at King County Juvenile Detention Center, a representative sample of 228 detained adolescents complete structured assessments, including the MFQ and the Massachusetts Youth Screening Instrument. Fifty youth also complete the Voice-Diagnostic Interview Schedule for Children. Internal reliability coefficient for the MFQ short form (SMFQ) is = .87. Factor analysis produces a unifactorial scale with item loadings of .43 to .78. At SMFQ cutoff > or = 10, sensitivity and specificity are optimized at 1.00/0.79. Prevalence of major depressive disorder is estimated at 32.1% (95% Confidence Interval = 25.3% to 39.2%). The SMFQ shows potential for depression screening of detained adolescents.

The psychopathology and treatment of bipolar disorder

In this chapter we review research on the diagnosis, course, etiology, and pharmacological and psychosocial treatment of bipolar disorder (BD). BD is a highly recurrent and severe illness, with high rates of suicidality and functional impairment. The disorder is heritable and appears to share susceptibility genes with schizophrenia. It is characterized by dysregulation in the dopamine and serotonin systems and by pathology in the brain systems involved in regulating emotion. Psychosocial stressors, notably life events and familial expressed emotion, significantly influence the course of the illness in the context of these vulnerabilities. Findings of randomized clinical trials indicate that psychosocial interventions enhance long-term outcomes when added to pharmacotherapy. Much remains to be clarified about the interactive contributions of genetic, neurobiological, and psychosocial factors to the course of the disorder, and the moderators and mediators of treatment effects.

Depression trajectories in relatively recent immigrants

This longitudinal study of 253 ever-depressed former Soviet immigrants (1) examined the life circumstances, demographic characteristics, and immigration demands of individuals whose depression lifted, or who remained or became depressed over a 2-year period; and (2) investigated whether immigration demands, local relatives, age at immigration, gender, education, employment, and marital status differed among the three groups. Depression was determined based on depression scores at baseline and at 2-year follow-up. Forty-three percent of the sample remained depressed, 26% became depressed, and 30% had their depression lift over the course of 2 years. The three groups did not differ with regard to demographic characteristics or loss of employment or a negative change in marital status over the 2-year study period. They did differ with respect to the presence of local family and immigration demands (P <.05). Those who remained depressed were less likely to have family in the area and had the highest immigration demand score at both time points. However, the effect for presence of local family was not significant when immigration demands were included in the analysis (P =.32). Analysis of variance (ANOVA) for repeated measures revealed that the group whose depression lifted experienced the greatest change in immigration demand scores over the 2-year study period. Our findings argue that clinicians should not expect immigrants' depression to always decrease over time and should assess depression by asking about immigration demands, even if depression was not present during an earlier clinical encounter.

Depression and cardiovascular disease: mechanisms of interaction

This article explores the relationship between depression and cardiovascular disease from a mechanistic standpoint. Depression and cardiovascular disease are two of the most prevalent health problems in the United States and are the two leading causes of disability both in the United States and worldwide. Although depression is a known risk factor for the development of cardiovascular disease, as well as an independent predictor of poor prognosis following a cardiac event, the mechanistic relationship between the two remains unclear. Depression is associated with changes in an individual's health status that may influence the development and course of cardiovascular disease, including noncompliance with medical recommendations, as well as the presence of cardiovascular risk factors such as smoking and hypertension. In addition, depression is associated with physiologic changes, including nervous system activation, cardiac rhythm disturbances, systemic and localized inflammation, and hypercoagulability, that negatively influence the cardiovascular system. Further, stress may be an underlying trigger that leads to the development of both depression and cardiovascular disease. This article reviews seven potential mechanisms for the relationship between depression and cardiovascular disease and presents the available evidence surrounding each mechanism. Finally, future directions for research are discussed.

A Population-Based Assessment of Women's Mental Health and Attitudes toward Women's Human Rights in Afghanistan

OBJECTIVE

To assess the health status of Afghan women and attitudes of these women and their male relatives during the period of Taliban rule toward women's rights and community development needs in Afghanistan.

METHODS

In household residences in two regions in Afghanistan (one Taliban controlled and the other not under the Taliban) and a refugee camp and repatriation center in Pakistan, structured interviews were conducted among a random sample of women and men exposed to Taliban policy and women living in a non-Taliban controlled area (724 Afghan women and 553 male relatives).

RESULTS

Major depression was far more prevalent among women exposed to Taliban policies (73%-78%) than among women living in a non-Taliban controlled area (28%). Sixty-five percent of women living in a Taliban-controlled area and 73% of women in Pakistan exposed to Taliban policies expressed suicidal ideation at the time of the study, compared with 18% of those in a non-Taliban controlled area. More than 90% of both women and men expressed support for equal work and educational opportunities, free expression, protection of women's rights, participation of women in government, and the inclusion of women's human rights concerns in peace talks. A majority of both women and men believed that guaranteeing civil and political rights (69%) and meeting basic needs (90%) were important for the health and development of their communities.

CONCLUSIONS

In Afghanistan under the Taliban, policies restricting women's rights were not the product of years of tradition or of social and economic deprivation. Instead, they were man-made policies as easily and swiftly revoked as they were instituted. Depression rates among women in Afghanistan, especially in Taliban-controlled areas, were extraordinarily high. Current efforts to rebuild Afghanistan must address these high rates of depression and other mental health problems to ensure women's full participation in development.

Is depression taxonic, dimensional, or both?

The current investigation examines the potential importance of item selection in the ongoing discussion regarding the taxonicity of depression. Following J. C. Coyne (1994), we contrast the taxonicity of "distress" with the taxonicity of a syndrome more focused on somatic symptoms (i.e., the involuntary defeat syndrome). Using 4 samples of 984 undergraduates, we first replicate the J. Ruscio and A. M. Ruscio (2000) results by showing that distress item indicators are dimensional. We then demonstrate taxonicity using items focused on somatic symptoms and reflective of disruption of multiple homeostatic mechanisms. Results suggest that item selection is central to the determination of taxonicity in depression.

Life events, stress and depression: a review of recent findings

OBJECTIVE

To review recent empirical prospective studies on the relation between life event stressors and depression.

METHOD

A systematic literature search focusing on predictive studies was carried out from 1980 to early 2001 using Medline, Embase and PsychInfo.

RESULTS

The empirical findings for the most part support clinical impressions of the relation of stressors to depression but at the same time provide some clearer understanding in relation to differences of stressor impact on depression type and on index episode, relapse or recurrence. Twin studies now provide the strongest evidence of the relative magnitude of effect of environmental stressors and genetic factors: the former explains at least as much of the variance in depression as our genes.

CONCLUSIONS

Continuing research into life events and depression have been fruitful especially those studies assessing the effect of stressors in combination with other aetiological variables such as genetic factors.